Incorporating ergonomic principles into endoscopic practice enhances quality and safety. To learn about strategies GI healthcare teams can consider implementing in the endoscopy unit to minimize injury risk and create a safe environment, we turn to Amandeep Shergill, MD, MS, FASGE.
Dr. Shergill is a Professor of Clinical Medicine at the University of California, San Francisco, and Director of Endoscopy at the San Francisco VA Medical Center. Her clinical interests include general GI and IBD, with a focus on IBD endoscopy. Her research interests include endoscopic ergonomics. Dr. Shergill is an alumnus of the ASGE Leadership Education and Development (LEAD) program, having participated in the inaugural class.
What drew you to begin your research in ergonomics?
When I was about to start GI fellowship, I learned that a female fellow left GI because of the pain she was experiencing during endoscopy. Around this time, I realized that although our program had a large number of female faculty, they were almost all transplant hepatologists, with only a single luminal GI female faculty member. After a few sessions of endoscopy, it was clear that the endoscope had not been designed with the full spectrum of users in mind – especially smaller female hands. The endoscope is not intuitive, and the one-size-does-not-fit-all design is clearly suboptimal. I was concerned that the poor endoscope design was contributing to the attrition of female endoscopists from the field. The endoscope companies only seemed interested in improving endoscope optics. The literature at the time was limited to a few survey-based studies which demonstrated a significant percentage of endoscopists who experienced an endoscopy-related injury. I was interested in demonstrating that performing endoscopy was a risky business, and that required me to learn more about work-related musculoskeletal disorders (WMSDs), which led me to ergonomics. I was fortunate to have very supportive mentors with access to excellent programs in the Bay Area. I am thankful for the mentorship and sponsorship of Drs. Ken McQuaid and David Rempel, and my ongoing collaboration with Dr. Carisa Harris-Adamson. My ergonomics research would not have been possible without the support of the ASGE, which awarded me an Endoscopic Research Award and a Career Development Award early in my career. I am also grateful to the ASGE LEAD program, which was an incredible experience that empowered me to navigate and grow in academic medicine.
What is one of the biggest misconceptions about ergonomics?
Most people become interested in ergonomics only after they develop endoscopy-related pain or injury and focus on what they can do to reduce their risk. The real benefit of ergonomics is in preventing injury in the first place, by designing work for the worker. Ergonomics is most effective when implemented by the entire GI team with support from management. In the endoscopy suite, all GI team members are our allies. Proactive implementation of engineering and administrative controls by a diverse and inclusive team is going to be more effective at reducing risk than anything the endoscopist can do in isolation reactively, after developing an injury.
Where should GI healthcare teams begin as they incorporate aspects of ergonomics into their workplace to enhance quality and safety?
The resources available to the GI team will likely depend on the practice environment. Large university and hospital-based practices may have an ergonomics program that can be leveraged to implement change. Smaller practices will need to start by raising awareness of WMSDs, implementing basic ergonomics training, and securing management buy-in to support change. There are many training resources available. The ASGE video Taking Care of You: Ergonomic Essentials for Your Practice reviews fundamental ergonomic principles to optimize the work environment. The October 2021 ASGE Quality Course included a session on endoscopy ergonomics. The CDC National Institute for Occupational Safety and Health (NIOSH) website reviews elements of an ergonomics program and includes guidance on implementing a program. The key is to train a team that contains representatives from all groups (MDs, RNs, technicians, and management) to recognize risk factors and symptoms for WMSD, and methods to reduce risk. The team determines which problems to focus on and which solutions to implement, using the most effective mitigation strategies. Ergonomics training gives the team the tools necessary to create an inclusive work environment. Investing in an ergonomics program is investing in a culture of safety.